Guest opinion: U.S. House health reform puts Montanans at risk

Billings Gazette – May 7, 2017

The U.S. House of Representatives last week passed a measure to repeal the Affordable Care Act and replace it with a bill that will increase health care costs for hundreds of thousands of Montanans and put coverage at risk for many across the state.

After failing to reach the votes needed to pass legislation earlier this year, politicians in D.C. changed the bill. Unfortunately, they did not fix the provisions that would result in over 20 million Americans losing coverage by 2026 and many more facing steep increases in out-of-pocket costs for insurance. Instead, House GOP leaders made the bill even worse, by eliminating protections for Americans who have pre-existing conditions, such as cancer, diabetes, heart disease, and even pregnancy.

The bill effectively ends Montana’s bipartisan Medicaid expansion program, which extended coverage to over 77,000 Montanans who would otherwise be uninsured and saved the state over $22 million in the first year. Throughout the 2015 session, we heard from Montanans across the state who faced serious health conditions but were unable to access coverage. Montana’s Medicaid expansion is saving lives, but now that health insurance could be ripped away from individuals who desperately need coverage.

Instead of helping make insurance more affordable, this bill actually makes it more expensive, by scaling back tax credits and subsidies provided to individuals who are accessing coverage through the health insurance marketplace. This will have a disproportionate impact on older Montanans, as well as those at lower incomes. Studies show that Montanans who are buying insurance from the marketplace could see out-of-pocket costs (such as premiums, deductibles, and copays) increase by an average of $4,606.

One of the most damaging and long-lasting changes would be to the overall Medicaid program. The House bill is proposing deep cuts in federal Medicaid dollars. States, particularly rural states like Montana, will be forced to make devastating decisions, as Congress attempts to cut over $800 billion in federal Medicaid dollars. Today, one in four Montanans (over 240,000 individuals) receive coverage through Medicaid. Children, seniors, low-income pregnant women, and people with disabilities all rely upon Medicaid for affordable coverage. If this bill becomes law, tens of thousands of Montanans could face loss in coverage.

The House GOP amended the bill to also eliminate some of the most popular provisions of the ACA, including protections for individuals who have pre-existing conditions. States would receive almost automatic approval to waive the requirement that prohibits insurers from charging people higher premiums for coverage based on their health condition. Those with pre-existing conditions would face skyrocketing costs for insurance. According to the Montana Department of Public Health and Human Services, over 400,000 Montanans had a pre-existing condition in 2009, the most recent year of information.

If insurers were to charge people the full expected cost of their condition, an individual with metastatic cancer could face premiums exceeding $100,000, according to one analysis by the Center for American Progress. Having a baby, without any complications, could run more than $15,000 more in premiums per year. Montanans facing a pre-existing condition would almost certainly run the risk of losing coverage, as a result of outrageous premium costs.

Congress can and should consider ways to lower health care costs and continue to expand access to coverage. This bill is not it. In fact, it is quite the opposite. It is time for each of us to tell Congress to do their job and protect the health care that Montanans need and deserve. The health care coverage of hundreds of thousands of Montanans hangs in the balance.

Heather O’Loughlin is co-director of the Montana Budget and Policy Center in Helena.